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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 097004177
Report Date: 03/08/2023
Date Signed: 03/08/2023 10:36:00 AM

Unfounded


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/19/2022 and conducted by Evaluator Lavinia Muscan
COMPLAINT CONTROL NUMBER: 25-AS-20221219095057
FACILITY NAME:PONTE PALMEROFACILITY NUMBER:
097004177
ADMINISTRATOR:KASNER, GREGORYFACILITY TYPE:
740
ADDRESS:3083 PONTE MORINO DRIVETELEPHONE:
(530) 677-9100
CITY:CAMERON PARKSTATE: CAZIP CODE:
95682
CAPACITY:250CENSUS: 152DATE:
03/08/2023
UNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Administrator Erik OlsonTIME COMPLETED:
10:50 AM
ALLEGATION(S):
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Staff are not quarantining residents with COVID-19.
INVESTIGATION FINDINGS:
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On 03/08/2023, Licensing Program Analysts (LPA) Lavinia Muscan arrived at the facility unannounced to deliver complaint findings into the allegations listed above and met with Administrator Erik Olson. Prior to visit, LPA completed required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID-19 infection to affirm no COVID-19 related symptoms. LPA ensured hand sanitizer was applied before entering the facility and the following Personal Protective Equipment (PPE) was worn: surgical mask.

During the investigation, the Department conducted interviews and reviewed documentation pertinent to the investigation.

The results of the investigation are as follows:

**Report continued on 9099-C**
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia MuscanTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 25-AS-20221219095057
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
FACILITY NAME: PONTE PALMERO
FACILITY NUMBER: 097004177
VISIT DATE: 03/08/2023
NARRATIVE
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Staff are not quarantining residents with COVID-19
An investigation was conducted into the allegation above. Staff interviews stated that when a resident tests positive for COVID, the facility quarantines the resident in their room. One staff is designated to go into the residents’ room with full PPE in accordance with Public Health recommendations. Per staff, if there are multiple residents who test positive for COVID 19, the facility has green and red areas designated for those who are positive and those who are negative residents. The residents are encouraged to stay in their area. If residents do tend to go to outside their designated area, they are redirected to the right area by staff. Public Health was in contact with the Executive Director during the time the residents were testing positive for COVID 19. Facility was also in contact with CCL during the time of positive cases. Records reviewed indicated that the facility was following their Infection Control on file with the department as well as in communication with the local public health office, therefore the allegation is unfounded. This agency has investigated this complaint. We have found the complaint was UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis.

Exit interview was conducted with Administrator and a copy of this report was provided to the facility. The signature of the Administrator on these forms acknowledges receipt of these documents.
SUPERVISOR'S NAME: Laura MunozTELEPHONE: (916) 263-4743
LICENSING EVALUATOR NAME: Lavinia MuscanTELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:

DATE: 03/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/08/2023
LIC9099 (FAS) - (06/04)
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